Provider Demographics
NPI:1881277523
Name:PUCHKO, DOUGLAS JOSEPH
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOSEPH
Last Name:PUCHKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 NANTASKET ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15207-1064
Mailing Address - Country:US
Mailing Address - Phone:814-243-2474
Mailing Address - Fax:
Practice Address - Street 1:239 4TH AVE STE 1801
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1716
Practice Address - Country:US
Practice Address - Phone:833-274-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling